MEDICARE: MS. SUE ANNE WRENN L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C001307	NC

General Provider Information

NPI Number	:	1447310453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE ANNE WRENN L.C.S.W.

Provider Business Mailing Address
First Line	:	5200 PARK RD
Second Line	:	SUITE 226
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3650
Country	:	US
Telephone Number	:	704-527-3077
Fax Number	:	704-527-3078

Provider Business Practice Location Address
First Line	:	5200 PARK RD
Second Line	:	SUITE 226
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3650
Country	:	US
Telephone Number	:	704-527-3077
Fax Number	:	704-527-3078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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